A wise friend who had completed residency told me prior to my starting training that the key to having fun was “never sit down when you get home from work.” Three years out of fellowship and practicing as a psychiatrist in Brooklyn, the words still resonate today.  The residents and medical students that rotate with me marvel at the stories of my full time acting career as a resident performing in ...

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I am so sorry I didn’t make this different for youThe telephone message arrived in my EMR’s inbox. A patient’s daughter had called and wanted to ask some questions about her mother. Her mother, Louise (name changed), had died about two weeks before. I hesitated before calling her, recalling her mother’s cancer course. Louise had been diagnosed with cancer at a relatively young age, in her late 40s. She received curative chemotherapy ...

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Question: What do you do when presented with abnormal lab results? Answer: Ask lots of questions. The nursing home just sent over a urinalysis on a patient of Dr. Carlyle. I am covering his practice for a few days. The test showed that an 82-year-old woman had 3+ white blood cells in her urine. “NKDA” was written in the margin, indicating she had no allergies. I sighed internally and called the nursing home. ...

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There’s a lot of talk about quality metrics, pay for performance, value-based care and penalties for poor outcomes. In this regard, it’s useful to ask a basic question. What is quality? Or an even simpler question, who is the better physician? Let’s consider two fictional radiologists: Dr. Singh and Dr. Jha. Dr. Singh is a fast reader. Her turnaround time for reports averages 15 minutes. Her reports are brief with a paucity of ...

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OpenNotes is “a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.”  According to their website, three million patients now have such access, generally online.  Participating institutions include the MD Anderson Cancer Center in Texas, Beth Israel Deaconess in Boston, Penn State Hershey Medical Group, Kaiser Permanente Northwest, and several others. Patients with a premium account in the My HealtheVet program at the VA have access to outpatient primary ...

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“Doc, can I ask you one more thing?” These words are classic symptoms for those patients suffering from the “one more thing” syndrome. We’ve all been there. The visit has ended, your hand is on the doorknob, and you’re about to leave the room. Precisely at that moment, your patient stops you and says he has one more thing to discuss. You think to yourself, "No! I almost made it out of ...

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I love old people, but I will not accept Medicare I love caring for patients -- young and old. And though I may not accept your insurance, I will always accept you. I’m still happy to care for Medicare patients even though I opted out of Medicare in 2006. Why don’t I accept Medicare? Let me fill you in. I do not accept Medicare because: Medicare treats physicians as criminals -- guilty ...

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Somewhere late morning, after rounding on my first day of internship, I received a call from my sister. “She wants to kill herself. What do I do?” We had been through this before with our mother, fifteen years ago, the week I moved out of her house. She ended up in the psychiatric unit as we packed our bags to move in with our grandmother. This time, fifteen years later, things were ...

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Your children deserve more than a minute at a clinic Yearly checkups for school-aged and older kids can be a great opportunity to help your child stay healthy. Don’t skimp by relying on a cheapo sports physical at a local drug store. They cannot offer the kinds of important things your own doctor’s office can do for your child at a yearly well check. We’ll review old issues and problems. Still getting ...

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Why do physicians behave badly? Maybe because theyre scared. A dozen set of eyes stared upwards.  The nurses ate their pizza and glanced back and forth between me and the dry erase board that I had recently filled with incomprehensible scrawl.  I had given this lecture many times and said the words over and over again.  And yet the response was always surprising. "Why do you think physicians get angry and ...

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